[This speech was to be made to a meeting of CPH personel and recovering physicians from the Long Island and New York area in October, 2000. The purpose of the meeting was to improve the service of the CPH to its clients, addicted and recovering physicians, and to re-evaluate the policies of the Medical Society and CPH in dealing with these people. When I arrived at the meeting, without seeing it, The CPH wouldn't allow me to make the speech, so I handed out copies of it to those present. Of the twenty or so participants, I received one phone call concerning the issues from a recovering doctor, and no word whatsoever from the CPH or the Medical Society. Hey, what's new? Read it and judge for yourself what exactly is so threatening or destructive about my comments below, or whether it is just too assertive, real, and adult for the fearful physicians (and believe me, they were) and paternalistic CPH to handle. By the way, it has been completely and utterly ignored by the CPH and the NYS Medical Society. as well as by the recovering addicts who attended the meeting.]

I want to say hello to all of you and congratulate your being here to participate in this potentially momentous enterprise. I also appreciate being given the opportunity to address you with my thoughts. The goals of this presentation are twofold: 1) maximize public safety, and 2) maximize and enhance early addicted physician recovery and restoration.

I open my remarks with an admonition, warning, prediction, and challenge: Until we stop viewing addicted physicians as maleficent thieves from the cornucopia of forbidden pleasures, as the current psychological/superstitious paradigm of addiction suggests, we will continue to reap the whirlwind of this mistaken belief. Only by forsaking similarly biased beliefs based on misperceived, antiquated, and generalized empirical judgments about addicts and accepting the medical reality of the neurobiological and emotionally neutral basis of addiction, stated by many addictionologists but fully and completely defined and discussed in my recently published book, will public safety and physician health both be maximized. Public safety, instead of being assured by current beliefs and policies, is being severely diminished for the ubiquitous and tantalizing luxuries of moralism, revenge and punishment of the addict, and the delusion of control by addictionology, politicians and their policy offsprings, authoritarian physician licensing administrations. In fact, until we provide the safe and accepting environment where most addicted physicians routinely and fearlessly refer themselves for recovery and monitoring, unnecessary patient and physician damage will be magnified and perpetuated by the same policies putatively designed to prevent them. That’s correct. The damage from addiction in physicians is enhanced more by the current policies meant to correct the problem, than by the problem itself. Early voluntary recovery, prior to any patient damage, is the only true method to curb and prevent patient damage caused by physician addicts. This can only be accomplished through fear-free self-referral in an public atmosphere I will describe later in the talk. The CPH is in a unique position and has the opportunity to ensure these changes if and only if it decides to. I predict that if the CPH courageously decides to make the changes it knows are correct, the best results will follow. I challenge the CPH to take this action despite its obvious fear of retaliation. So be it.

Of the many causes of potential and possible physician "impairment" leading to patient damage, addiction is the last medically based disease that is currently punishable by the Health and Education Depts. of NYS in the absence of documented behaviors injurious to patients. One of our goals tonight is to change the word "is" to "is no longer." To enhance their public image, the NYS Depts. of Health and Education, are spending inordinate time and money scapegoating harmless addicted physicians for the myriad of medical mistakes, errors, and frauds currently widespread in the field of medicine, while the real perpetrators of these damaging behaviors are being ignored, left untouched, and allowed to repeat this damage. (National Academy of Medicine studies on medical errors) The CPH must dissociate itself from these state departments and be transformed to combat, confront, and challenge the rationale and legality of the hypocritical discrimination of addicted physicians in the name of public safety until this scapegoating is stopped. Current CPH secrecy and paternalism which plays into the hands of these departments must be replaced by practical confidentiality and customer service based on the realities and facts about addicted physicians rather than by commonly held biases. The issue of what it means to be an "impaired physician" needs to be publicly and factually defined and supported.

Under the current system of dealing with addicted physicians, as truly helpful as it is compared to past systems, we are still, however, daily witnessing physician addiction associated morbidity and mortality, ruined lives, families, and practices, and other horrifying consequences stemming from addictions but more so from the public administrative reactions to these addictions. None of these is an acceptable result or is necessary to ensure public safety in dealing with addicted physicians. Improper attitudes and beliefs surrounding addictions and the consequent punitive handling of physician addicts is responsible for most of these disastrous outcomes by forcing addicted physicians underground where they are more prone to cause damage. There is a better way to handle addictions among physicians without sacrificing any public safety. In fact, the attitudes and policies I am suggesting below will, I believe and predict, increase both public safety as well as save more addicted physician’s lives and life styles. I believe the CPH will be more effective in carrying out its mission if it adopts these suggestions, most of which have already been made by many forensic addiction specialists such as Milton Burglass, Doug Talbot, and others.

For this discussion, I will assume the CPH, as currently organized, is sincerely motivated, is doing the best it can under its misconceived directives and professional biases, and is truly interested in improving its service to the medical society, the clients, and the public. I will be outspokenly clear in my suggestions, will not critique the current system, and will, instead, outline my views on what I think its roles ought to be, and why. This is the purpose of this convention. My views are based on a realistic and scientific concept of addiction which I will heartily propound and defend and on my own personal experiences with the CPH system over the last eleven years. Incidentally, I am clean and sober 9 years in October. For a complete recitation of those experiences please see the article on my web site-- http://www.nvo.com/hypoism/thedoctordrugwarwrongandwastefulp1/

Irrespective of how the public views and misperceives addiction, we must make a clear and direct statement on the causation, course, and recovery of addictions among physicians as well as on policies necessary to deal effectively and safely with these addictions. This statement must be derived from valid studies of addictions as well as addict's documented behaviors. We must define what a physician addict is and, most importantly, what she/he isn't. We must derive our conclusions and policies based on these realities, not on what we perceive to be the public's fear and irrational beliefs or on what we fear their reactions to our policies will be. We must rationally and fearlessly lead, not follow. Moreover, our leadership must be active and proactive, rather than conciliatory, diplomatic, passive, and submissive. Physician addicts are not expendable and need not and should not be sacrificed on the cross of current irrational beliefs about them and their addictions. Our two critical concerns, public safety and addicted physician recovery and restoration are not mutually exclusive. In fact, they are parallel realities that will either both or neither come to pass. This is so because only the correct addiction concept or paradigm, if we find it and use it to make policy decisions, will maximize both contingencies. This must be our goal and it will take some work on all of our parts. This conference could well be the beginning. There's no doubt we need a beginning.

There is a paradigm that explains the origin, etiology, pathophysiology, course, and recovery of addictions. We just don't know what it is yet. It is clear, however, that addicts don't volitionally go out of their way to become defiant and deviant addicts and public pariahs as believed by the current addiction paradigm. The word DISEASE is appropriate and useful, besides being a reality, to describe a condition such as this. We need to be clear that addiction is the result of a disease and move on from that even though the disease has not yet been completely delineated. Several things are clear about this disease: It is not a manifestation of a criminal mind, societal defection, immorality, or irresponsibility. It is not a psychiatric or psychological disease in the usual sense of these words and does not require a psychiatrist or psychologist involved to either diagnose or ensure full, complete, and maximal recovery. Likewise, medications of any sort are not required for the simple addicted physician.

We also need to make public, as clearly and loudly as necessary, the existence and outcomes of the process we are today beginning despite any possible public reaction. If we can't clarify the current mess surrounding physician addictions, who can or will? Only those we don't want to.

Parenthetically, I have personally developed a purely science-based neurobiological paradigm of addictions that more clearly derives the following points. The correct addiction paradigm must be used to understand and produce policies for addicts. My phone number, address, e-mail address, book, and web site are listed at the end of this handout for those interested in pursuing and studying my disease paradigm further.

As a result of our new and better understanding, knowledge, and delineation of addictions we must openly show and act on our acceptance and comprehension of, and solidarity with, addicted physicians, in or out of recovery. Would we treat leukemic, diabetic or arthritic physicians differently? Addicted physicians are equally and similarly victims of a recoverable medically-based disease. We need to make this clear as definitively as necessary. Addiction is not willful misbehavior as it is currently defined. Categorically, there should be no punishment for simple addiction among physicians, only very specific requirements for removal from and re-entry into practice following recovery. In fact, punishment in addicted physicians needs to be reserved for proven patient harm and non-addiction-related crimes exactly the same as in nonaddicts. A monitored recovering addict physician is safe and innocent unless proven otherwise, not the other way around as is currently believed. Documented behaviors must be the only criteria for or against addicted physicians used in this process, not feelings, opinions, beliefs, assumptions, generalizations, or prognostications based on them. Subjectivity, moralistic judgments, and discretion based on these biased beliefs must be completely removed from our policy decisions. The burden of proof must be on the licensing agency to prove physician danger, as in all other areas of civil and criminal law, rather than placed on the physician to prove she/he is not - an impossible scheme. Administrative law must be abolished for simple addictions. Moreover, the same defendant rights must be preserved for physicians accused of punishable actions by administrative boards as in all other American courts. The CPH needs to be placed in a position of authority in these areas not just advocacy. My remarks below are derived from the above principles.

For us to resolve the role of the CPH and the Medical Society in dealing with public safety in the face of physician addiction while ending discrimination against and damage to these same addicted physicians, we must develop an objective, realistic, and public statement of the problem, its effects and solutions. The two issues of public safety and protection of the addicted physician are both to be addressed as equally valid and important outcomes of this process.

Let's start with the problem and some of its realities.

1. A certain number of physicians will get addicted to mood altering substances every year. (Reality - this is the same reality as for nonphysicians. In physicians, however, addiction must be perceived as an occupational hazard and disease, not a personal failing or a defection against society's laws or mores.)
2. There is a valid medical disease causing these addictions. (It is not a psychiatric disease and is not associated with psychiatric disease and the stigma of such a designation unless there is real objective evidence for a concurrent psychiatric disease.) The disease of addiction needs to be defined as such and stated.
3. These addicts don't get addicted voluntarily. (Destigmatization and Decriminalization)
4. These addictions may be dangerous to their patients. (The physician is not to be, however, considered and labeled dangerous unless there is concurrent objective evidence for actual and documented dangerousness in conjunction with the addiction. This reality needs to be documented and studied more thoroughly and the data published and publicized.)
5. Addicted physicians should not practice medicine while addicted. (Public safety)
6. The addicted physician needs and deserves the acceptance, support, and assistance of his peers, medical society, CPH, partners, and hospitals. (Destigmatization and De-ostracism of the addict. Protection of the addict's life, livelihood, and practice.)
7. Recovery from addiction is a reality and results in a viable physician under no constraints other than those dictated by objective monitoring. Recovery in the simple addicted physician is not a psychiatric process nor does it require psychiatric intervention unless requested by the addict. Recovery is the responsibility of the addict. The CPH may guide and assist in this recovery, but never coerce any specific treatment or deny advocacy based on how an addicted physician eventually meets the objective requirements necessary to return to practice. Forced psychiatric intervention is only indicated when the need is proven for definitive public safety indications. Psychiatric intervention is never indicated to appease an authority. This is psychiatric abuse.
8. Objective recovery from the addiction(s) is a prerequisite to returning to practice. (Public safety)
9. Relapse is a reality in the course of addiction recovery and needs to be accepted, not punished nor used against later restoration. (Destigmatization and Decriminalization of relapse) Special policies must be devised to help relapsers not break criminal laws during these unwanted, but nevertheless, acknowledged occurrences.
10. Recovery can and needs to be objectified and monitored.
11. The recovering physician needs to be helped financially, vocationally, and legally as necessary during his early recovery prior to returning to practice, especially if the licensing agencies unfairly and interminably interfere with license restoration. (This assistance must be provided by and funded by the medical society. Vocational and legal support specific for recovering doctors, funded by the medical society, to assist recovering physicians, is absolutely necessary.)
12. Recovery must be objectified, documented, and monitored based on specific and objective criteria, not on any personal bias of the CPH or licensing agency's personnel. CPH is an advocate and monitorer, not a parent or policeman. How an addicted physician recovers is his business alone. To return to practice only these objective criteria must be specifically met. They will be the same for all clients.
13. Objectivity needs to rule the process. Criteria for recovery must be public, objective, based on absence of addiction related behavior, and clear. Discrimination by the CPH or the licensing agencies based on personal beliefs, feelings, and opinions on any issue have no place in this process. Behavior got us into this mess and behavior alone will get us out of it.
14. This entire process needs to be public in all aspects to assure the public that their safety comes first, but that protection of physicians is equally our concern. (Recovery becomes destigmatized and open)

If the CPH is to remain in charge of this process for objective reasons there must be a public statement by the Medical Society to this effect explaining the above realities. All physicians in the state, members or not, must be made aware of these realities and their medical basis. Current and future addicts must know what is in store for them when they realize they're addicted.

The CPH must exist for only the following reasons and these reasons must be made known to all physicians. To avoid treatment and judgment biases, recovering physician volunteers, not "professional" treatment personnel or psychiatrists, need to be hired and paid to run the CPH and fulfill the following roles:

• The primary purpose of the CPH will be to take full responsibility independent of needs or policies of outside groups, in the name of all physicians in the state, for dealing with addicted physicians to ensure their helpful, fair, and equitable treatment in all areas concerning their professional life and credentials. Their roles and how they carry them out will be clearly and publicly defined in writing. To assure this is accomplished, there will be a CPH-independent advisory committee made up of volunteer recovering physicians to oversee the CPH, take unresolved client complaints, and report to the medical society which will be given the power to intervene when and in any way it deems necessary to correct CPH's shortcomings. Every physician in the state will receive a written document defining the roles, responsibilities, and powers of the CPH. Along the same lines, every addicted and recovering physician in the state may voluntarily, through the CPH, make himself known to all others. This would allow access to experience with discrimination or recovery, networking for whatever purpose, class action law suits by these physicians, or any other issue on which recovering addicts would like to communicate among themselves. A system for this networking will be duly and immediately established. Unity of purpose and solidarity.
• The CPH will have no affiliations or connections to any outside group but will work with and cooperate with other addict advocacy groups where appropriate for the benefit of their clients. Independence.
• Centralize and enable the preemptive voluntary admission of addicted physicians to begin voluntary recovery and who enter under their own steam without fear of loss, punishment, or being turned over to any authorities whatsoever. Fear-free access to advocacy and recovery. Fearless entry of addicted physicians into recovery overseen by the CPH is an absolute necessity to prevent addicted physicians from believing they need to keep their addictions hidden from authorities. This is the best way to prevent both patient and client damage. Realistic Harm Prevention.
• Confront addicted physicians who display objective signs of addiction. Confront.
• Help the addicts take the appropriate measures to stop practicing medicine and to place their practice into others' hands temporarily. Facilitate entry into recovery.
• Protect the addict from the criminal justice system, discrimination, and theft of his practice. (must become proactive) Protect client's livelihood and freedom.
• Advise the addict about her/his disease, proven methods of recovery, and assist in entering recovery. The method and path of recovery is, however, none of the CPH's business. Advise.
• Monitor the recovery objectively according to specific and well defined criteria. Provide, free of charge, whatever monitoring is necessary as well as monitors as well as their easy accessibility. Monitor and Document recovery.
• Provide free legal, financial, and vocational assistance in cases where these are necessary before and after re-entry into practice. Assist.
• Active, firm, and resolute advocacy in and participation in punitive administrative license-related hearings. Active Advocacy.
• In unresolved licensure cases, provide lawyers and lawsuits to fight discrimination and abuse of administrative discretion. Sue.
• As the recognized representative of the medical society, the CPH will actively and publicly lobby and demand appropriate legislative changes concerning the state's licensing and punitive powers. Lobby

Definitive and public roles of the CPH: Unity of purpose and solidarity - Independence - Realistic Prevention - Confront addicts - Facilitate - Protect - Advise - Monitor and Document recovery - Assist - Advocate - Sue discriminators - Lobby the legislature.

The CPH thus becomes a trusted helper in the process of addict discovery and recovery, not a therapist, policeman, parent, despot, or punisher. This is accomplished while ensuring complete public and addict safety.

As a practical summary, the following is excerpted from my book, Hypoic's Handbook, from a chapter entitled, "Legal Discrimination."

Why couldn't the medical society and the health department get together and say, "We know that a certain percent of our professionals are going to become addicted. It happens like clock work, just like outside of our profession. Some people are going to be addicts. Let's let them know that we know this, and tell them right off that when they find out they are addicted, they should come to us and we will help and offer protection from the stigmatizing world who may want to punish them. In fact, we will defend them from criminal prosecution just in case any cops get their hands on them, because it would be unfair to prosecute anyone with an occupational hazard type of illness. We will provide them with their drug of choice legally while they are preparing to enter detox so they won't have to obtain it illegally and risk being arrested and felonized. We will offer them places to get detoxed and time off from their job to take care of this addiction, as needed. No questions asked. We will not tell anyone about it. They will not lose their jobs or reputations. We will not allow their partners to use the addiction to steal their part of the practice away from them. There is a law called "the Americans with Disabilities Act" that will be changed to prevent anything bad from happening to them because they are addicts. We need our professionals too much to throw them away just because they became addicted. Addicts who actually hurt a patient due to their addiction will have to deal responsibly with that, but no addicts will be assumed negligent or incompetent just because they are addicts. They will get the same treatment any other professional gets when a patient is injured, irrespective of the addiction. The only thing we demand is that they don't go back to practice until they are in good recovery, which will be decided by clear, specific, and realistic criteria already made public. These criteria will be written down on paper and will have nothing whatsoever subjective about them. The criteria will be established by addiction specialists and agreed upon by your medical society, including recovering addict professionals who have no ax to grind. All will be fair, realistic and above board."

This excerpt demonstrates the attitude we all need to exhibit before beginning the process of re-evaluating the current system of dealing with addicted physicians. It is realistic, assures public safety, protects the addict, and allows for the earliest possible entrance into recovery prior, hopefully, to the occurrence of any disasters to patients or the addicted physicians. This is our goal, isn't it?

Moreover, the current CPH employees must be willing to put their personal needs and desires on the line in the name of integrity to confront and demand these necessary changes from the Medical Society and the state agencies. I hope their integrity prevails in this process.

In the interest of opening this process to the public, I respectfully request this paper be distributed to all CPH participants, and, in fact, to all NYS physicians to allow and stimulate an open debate on its merits. Any and all debate on the above issues and their bases should made public as well. Secrecy surrounding the principles producing the decisions of the CPH and Medical Society is the cause of the current need for re-evaluation of the role of the CPH. When this secret policy-making ends, realistic and unbiased policy will, I predict, be forthcoming to the benefit of both public safety and all physicians of New York State. Moreover, many other state medical and professional societies need to be apprised of this work so that their members can similarly benefit from our diligence.

Thank You.

Dan F. Umanoff, M.D.

Author of Hypoic's Handbook, The Hypoism Paradigm of Addictions. President and founder of The National Association for the Advancement and Advocacy of Addicts, a not-for-profit organization offering free educational and legal services to discriminated against and abused addicts of all varieties, "substances" and "behavioral," and their families.

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